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Bed-blocking still taking toll on NHS

There is growing evidence of worsening problems within the Scottish NHS as it tries to cope with greater demand for its services.

The latest telling statistic deals with the rate of bed-blocking, the term for patients occupying beds when they are medically ready for discharge because arrangements have not yet been made for their care back in the community.

Bed blocking is at its highest rate in four years, with the number of patients waiting more than six weeks to be discharged having tripled over the past year.

To take just one month, July, 274 patients waited more than four weeks to be discharged from hospital this year, up from 118 a year ago. Of them, 175 waited more than six weeks, compared from 59 in July 2013.

This is worrying. Bed blocking has a ripple effect back through the hospital system. It puts pressure on the availability of ward beds, which can mean that patients face delays being moved on to wards from accident and emergency (A&E) or other departments.

This was the case two winters ago when bed blocking was implicated in causing some of the bottlenecks in A&E as patients lay on trolleys for extended periods due to a lack of available ward beds.

But it is also worrying because of what it says about the funding and availability of community-based care. The latest figures show that, in the majority of cases, patients were delayed in hospital by a shortage of available care home places or because they were awaiting funding to pay for a care home placement. In some places, such as Lothian, there has been huge pressure on care home places because some homes have been closed to new admissions due to poor Care Inspectorate reports. Both NHS and social care budgets, meanwhile, have been seriously stretched due to public funding constraints, which is likely to be contributing to the delays.

And these delays have another serious consequence, namely that they can cause a deterioration in the strength, health and wellbeing of the patients concerned. The prompt movement of patients into the community once they are clinically ready to leave is in the interests of patients, hospital and NHS staff.

It would help, of course, if fewer people found themselves in hospital in the first place. In the absence at present of the right mix of community-based health services that could help people avoid unnecessary hospital admission, too many are ending up in wards.

Efforts are being made to better integrate health and social care services so that more patients are cared for for longer in the community, but that is not happening swiftly enough.

The Herald's NHS: Time for Action campaign has been highlighting the growing pressures on the health service caused by the ageing population.

These latest worrying figures on bed blocking only highlight the urgency of the need to build greater health and care capacity outwith hospitals, but politicians must also face a difficult likelihood: that the NHS and social care need to be better funded.

Contextual targeting label: 
Health

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